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Everyone knows that a balanced diet can improve your overall health, but can it improve your psoriasis? New studies are looking at the impact of certain foods and nutritional supplements on the disease. Learn from a naturopathic physician what dietary changes may be helpful and what ones should be avoided.

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Everyone knows that a balanced diet can improve your overall health, but can it improve your psoriasis? New studies are looking at the impact of certain foods and nutritional supplements on the disease. Today, we'll learn what dietary changes may be helpful and what should be avoided.

I'd like to welcome Dr. Amy Neuzil, a naturopathic physician practicing at the Plum Blossom Wellness Center. She joins us from Austin, Texas.

Marcie: I guess we can start with the negatives. Are there general categories of food that people should avoid if they have psoriasis?

Dr. Amy Neuzil: I think the biggest category is inflammatory foods, things like white sugar - things that stimulate the system in a negative way and can negatively affect the immune system.

Marcie: Talk a little bit more about inflammatory foods. What does that mean?

Dr. Neuzil: There are foods which create inflammation in our body, and there are foods which help us to fight inflammation in our body. Some of the most common pro-inflammatory foods are things like white sugar, refined flour, red meat, alcohol, trans fatty acids, hydrogenated oils, artificial sweeteners, artificial colors.

Marcie: How does that affect psoriasis?

Dr. Neuzil: Psoriasis tends to be a very inflammatory process. People with psoriasis actually have a much higher skin turnover, obviously, but they also have a much higher level of arachadonic acid, which is the main inflammatory protein in their skin. It's like an entire body inflammation, and their whole body is affected even though it only really shows on the skin. So, really anything that people with psoriasis can do to decrease that inflammation is going to help with their disease.

Marcie: What would be then an anti-inflammatory food?

Dr. Neuzil: Garlic is one of the most common and most talked about [anti-inflammatory foods]. Also, things like ginger, turmeric - which is one of the main spices in curry - pineapples are very anti-inflammatory because they contain a lot of enzymes. Fish and fish oil especially is very anti-inflammatory. And there have been some studies on people eating fatty fish and they showed that with a six-week period of eating a higher percentage of fatty fish, they had 11 to 15 percent symptom resolution, which is pretty significant for just changing one thing in your diet.

Marcie: When you talk about fatty fish, are you talking about omega-3 fats - salmon, halibut, those kinds of fish?

Marcie: Can you get the oil separately, or is it best to eat them with the fish itself?

Dr. Neuzil: You can get the oils separately, and that's extremely effective as well, but the study was done on the whole fish.

Fish oil is just such a great anti-inflammatory in general. It's on par with the more common anti-inflammatories like COX-2 inhibitors and over-the-counter medications like aspirin, Tylenol, ibuprofen, things like that. We don't think of it as a pain reliever but over the long term, it can be. It can be almost a miracle, simply because it decreases the pain, and it can decrease the inflammation systemically - not just to the skin.

Marcie: How much of this fish oil do people need to ingest?

Dr. Neuzil: It really depends on what their source is. The people [who] were eating just the fatty fish, ate, I think, 170 grams of fish daily. If you are having a fish oil supplement, for people with psoriasis, I recommend taking, as a general guideline, twice what's labeled on the product.

Marcie: Are there certain brands that you would steer people towards?

Dr. Neuzil: With the fish oil, it's very important to make sure that the company is testing their products for mercury levels and things like that because, unfortunately, our seas are somewhat contaminated with heavy metals. I've had really good luck with the company Nordic Naturals, Tyler and Menogenics as well.

Marcie: Are these readily available at health food stores?

Dr. Neuzil: It depends on the health food store. I think these are more upper-end products, but I know Whole Foods carries Nordic Naturals. Some of the local pharmacies carry the Tyler and the Menogenics.

Marcie: I want to go back to things that we should avoid. Why do you recommend avoiding COX-2 inhibitors?

Dr. Neuzil: It's very ironic. They have found that the COX-2 inhibitors for psoriasis are supposed to reduce the breakdown of arachadonic acid. That's what they do in the typical person, but they've found that the plaques of people with psoriasis actually contain some of these COX-2 inhibitors.

It may be creating more inflammation in that involved skin.

Marcie: Do we know why that happens?

Dr. Neuzil: We don't have a good reason for that. And, of course, people with psoriasis are very prone to taking over-the-counter anti-inflammatories, and very often even physicians don't know that it could be a contraindication.

Marcie: You would recommend that people with psoriasis avoid all of these?

Dr. Neuzil: I would recommend that they try and decrease them as much as possible. Obviously, for pain management, they absolutely need them. That's a risk/benefit sort of issue. If they are getting more out of taking them than they would be out of avoiding them, then for quality of life reasons it's more important to take them. But if they can avoid them, I think it's a good step toward helping to resolve the situation.

Marcie: For many different diseases, health experts have talked about increasing dietary fiber, and I understand that's something you recommend for people with psoriasis as well.

Dr. Neuzil: Absolutely. Fiber is one of nature's incredible cleansers and anti-inflammatories. It helps our bodies process any sort of toxin. It helps our body to pull out inflammation, basically. It's the perfect anti-inflammatory, and it's readily available. Even if you don't like high fiber foods, you can take Metamucil or Citrucel or some over-the-counter, inexpensive fiber supplements.

Marcie: How much should people take - more than you might take if you were using it for constipation?

Dr. Neuzil: If people are getting the RDA [Recommended Daily Allowance] for fiber, I think they're pretty well covered unless they do have a constipation issue.

Marcie: Another kind of oil that's been recommended as a cancer fighter is flaxseed oil.

Dr. Neuzil: Absolutely.

Marcie: How does that work for people with psoriasis?

Dr. Neuzil: Flaxseed oil is a fantastic anti-inflammatory. The only problem is, about 5 to 10 percent of the population cannot convert flaxseed oil into the end products that we're looking for. So, I prefer fish oil just because it's a guaranteed anti-inflammatory where the flax oil doesn't work in a small percent of the population.

Marcie: When we talk about these fats, how different is a fish oil or a flax oil from animal fats - butter in particular?

Dr. Neuzil: It's almost the direct opposite. Something like butter or a meat fat is a saturated fat. It actually creates more of that inflammation that we've been talking about, and it has a negative impact on body weight and the way your body processes the other foods that you eat. Whereas a liquid fat like the fish oil or the flax oil, which is highly anti-inflammatory is the reverse. I mean, it helps your body with the inflammation situation. It helps your body to process the foods you're eating more effectively. It also helps to maintain a normal weight.

Marcie: Well, being overweight is clearly bad for a lot of reasons, but why specifically for people with psoriasis?

Dr. Neuzil: Any kind of an excess weight really detrimentally affects any sort of chronic disease process. Not only that, psoriasis patients have been shown to have increased levels of insulin in their blood, which is interesting because that's normally associated with pre-diabetes or syndrome X as they're now calling it. So because of this, if they can avoid the sugars which are pro-inflammatory, they're doing themselves sort of a dual duty: They're avoiding the sugars for the psoriasis but also avoiding the sugars to decrease the insulin levels in their blood.

Marcie: Have you actually seen people who were overweight and started following some of these dietary recommendations see improvement in their psoriasis?

Dr. Neuzil: I really have. It's hard to say whether it was the weight loss or the diet or the combination of both that was making the difference, but certainly people see vast differences when they start losing weight and really change their diet.

Marcie: You've mentioned animal fats and meat, in particular, what about a vegan diet or vegetarian diet?

Dr. Neuzil: Vegan diets and vegetarian diets have been shown to be extremely helpful in psoriasis, which brings to mind the question as to whether there's some sort of reaction specifically to meat. We don't really know, but they've done experiments, certainly, on vegans, that have shown that they have far less incidence of psoriasis. Even people who were psoriatic before becoming vegan had resolution of their symptoms. Also, there was a study done on World War II POWs. They had incredibly dramatic remission rates when they were prisoners of war, and their symptoms returned when they came home and changed their diet. Simply because when they were prisoners of war, they had simple basic, no meat diets, and they had increased sunlight exposure, which are both extremely good for psoriasis.

Marcie: I want to go back to the idea of vegan versus vegetarian. Is there a difference if you're a vegetarian who might eat eggs and butter and milk and cheese as opposed to a vegan who would not have those in their diet?

Dr. Neuzil: That's an interesting question. I've never seen a study comparing the two groups - vegan and vegetarian - but I do know that very many people with psoriasis have some sort of an underlying food allergy and certainly if that allergy were to something like dairy, then I think vegan would be a better choice. If they're not affected by dairy, then I don't think there would be too much of a difference between vegan and vegetarian for them.

Marcie: So, one way that somebody might see how this works is to eliminate everything and then start adding in?

Dr. Neuzil: Exactly, and that's by far the gold standard. Any of the food allergy tests that are out there are really not hugely reliable. Eliminate something for two weeks, then try it again and see how your body reacts over the next four or five days.

Marcie: What about green vegetables - are there certain kinds of vegetables or certain kinds of fruits that actually have an effect on inflammation or on plaque on the skin?

Dr. Neuzil: There are fruits and vegetables that have an effect on inflammation. Any sort of green, leafy [vegetable] is very anti-inflammatory. Something like blueberries, that's extremely anti-inflammatory. Beets, anything with a really deep pigment [is anti-inflammatory].

Marcie: You mentioned blueberries, and I just had to laugh for a second. Blueberries are essentially the magic bullet, aren't they?

Dr. Neuzil: They are. They're the cure-all.

Marcie: Is there some correlation between [antioxidants] and inflammation?

Dr. Neuzil: There is. Any sort of a high antioxidant content can help decrease overall body inflammation. Although, as a caveat here, there is an interesting contraindication with psoriasis for vitamin C.

This is the only time ever in my career that I would recommend not taking vitamin C. Vitamin C stimulates something called cyclic GMP in the body. They've found that in psoriasis the ratio of cyclic AMP to cyclic GMP is abnormal, which basically affects the inflammation cascade and the ways the skin is processed. By having vitamin C, you're stimulating the one that's overly high anyway.

Marcie: What about vitamin supplements in general, are those dangerous for psoriasis patients?

Dr. Neuzil: The small level of vitamin C that you're getting in a multivitamin I don't think is going to be any kind of a problem. For some of my other inflammatory diseases, I would recommend larger doses, and psoriasis is not one of those. Certainly larger doses of something like vitamin E or alpha-linoleic acid are extremely helpful.

Marcie: Let's talk about some of the supplements that aren't green leafy vegetables and blueberries. What would you recommend people take specifically?

Dr. Neuzil: There are a few things that I've found that are really helpful. One of the most helpful for people with really high inflammation, obviously the fish oil supplement, but outside of that something like a proteolytic enzyme, which is an enzyme that you take on an empty stomach that actually goes into your bloodstream whole and digests inflammatory particles [is also helpful]. The most common one out on the market is Wobenzym. There's also a great one called Vitalzyme.

Marcie: How much of this do you need to take?

Dr. Neuzil: The Vitalzyme, I typically recommend three capsules twice a day. The Wobenzym is a little bit higher dose, usually six to nine capsules twice a day.

Marcie: But it's the same enzyme?Dr. Neuzil: It's the same enzyme. The Vitalzyme has a little bit stronger action.

Marcie: So there's that. [Is there] anything else?

Dr. Neuzil: There are lots of things that are really helpful for psoriasis. Chromium picolinate is something that I recommend pretty much across the board. [I recommend] 200 micrograms a day or more. It tends to help people cut their sugar cravings down as well. So if they're trying to change their diet, it can be extremely helpful.

Marcie: What about selenium?

Dr. Neuzil: Selenium is an incredible mineral. Most of us tend to be deficient, but especially people with psoriasis simply because they are using so much in turning over all that extra skin. So the selenium is a great idea.

Marcie: You mentioned garlic. Were you talking about taking that in dry or capsule form, or were you talking about eating it?

Dr. Neuzil: Well, I really like the Italian food, so I was talking more about eating it, but the capsules are good too.

Marcie: I've heard that oftentimes it's best to get certain kinds of vitamins through the food itself as opposed to taking a supplement because of the way that your body absorbs it. Is that true for garlic?

Dr. Neuzil: I think that we're designed to absorb things through our food, but I have seen good results with people who were taking capsules who didn't really like garlic in their food. I think although the food is better, capsules are still effective.

Marcie: You mentioned zinc a little earlier.

Dr. Neuzil: Zinc, across the board, is pretty well-absorbed. It's something that is readily available. Zinc supplementation is pretty easy to find. There's no real preferred type of zinc, but it's very helpful with weight reduction and as a good immune booster and anti-inflammatory at the same time.

Marcie: What about B vitamins, folic acid, things like that?

Dr. Neuzil: Just like any person in this country needs B vitamins and folic acid, I think people with psoriasis do. I wouldn't say they have an extra need, but certainly there is a need.

Marcie: You mentioned avoiding vitamin C. Are there any supplements besides vitamin C that you would recommend that psoriasis patients avoid?

Dr. Neuzil: Interestingly enough some other of the cyclic GMP stimulators - things like biotin and ginseng are not the best things to take for people with psoriasis.

Marcie: Why not?

Dr. Neuzil: Well, they also stimulate that same ratio that's sort of off in psoriasis anyway. Also, things that activate the specific immune pathway that can be involved with psoriasis, I typically try to avoid with those patients. Things like burdock, echinacea and inula.

Marcie: You've listed several of the things besides zinc that people might be taking in the wintertime to help boost their systems to fend off colds or flus. It seems like you have to decide what is important to you at this point.

Dr. Neuzil: I think the best thing people with psoriasis can do to fend off the colds and flus are zinc lozenges. They really will keep your immune system going, and the zinc is something that they need anyway.

Marcie: Is there any danger between adding some of these supplements to your diet and perhaps medication that a person with psoriasis might be on? [Are there] any negative interactions?

Dr. Neuzil: As always, when you're starting any supplement, you should check with your doctor, but, typically, there aren't too many interactions with these things because they are so basic. Certainly the fish oil, I haven't seen any information that it interacts with any medications. The zinc could interact with some, so check with your doctor, and sometimes it's matter of taking it at a different time of day than you take your medication.

Marcie: We talk about all the beneficial effects of changing your diet, but are there other potential issues that may come up with a person's digestive system in diet change?

Dr. Neuzil: Usually, people notice that their digestion gets better simply because they are eating a higher quality of food. If they are cutting out the sugar and some of the processed things, most people report that their digestion gets better. A lot of patients with psoriasis have digestive issues anyway, and that's actually been proposed as a potential cause for psoriasis - a "leaky gut" type syndrome.

Marcie: It seems that the best thing that you could do is go down to the basics, and then start slowly adding things in and see how they react.

Dr. Neuzil: Absolutely, and that can be a difficult process but so valuable in the end because if you can reduce your symptoms, that's a big difference.

Marcie: How soon would you see an improvement? Would it be within two weeks, four weeks?

Dr. Neuzil: If you go down to a really basic diet: steamed veggies, whole grains and very little meat, or nonreactive meat, then you should see improvement I would say, within two to three weeks. Then you can start slowly adding in.

Marcie: If you started in this blank slate, could you start the supplements at the same time, or would you start those one by one as well?

Dr. Neuzil: I would start the supplements at the same time unless you notice a reaction.

Marcie: You mentioned earlier that you've seen improvement in patients [who] have lost weight. What other kinds of changes have you seen?

Dr. Neuzil: Well, certainly, when weight changes, everything changes. There [are] a lot of emotional issues that go along with it. If people can reduce their weight or if they're seeing symptom resolution, it's life-changing because they have this renewed sense of self-esteem. They have a renewed outlook on life, basically.

Marcie: Most dermatologists don't give specific dietary recommendations for people who have psoriasis. Why do you think that that is?

Dr. Neuzil: I think a lot of it is just a medical paradigm. I mean dermatologists have seven minutes to spend with their patient, and they are bound to that by protocol and by insurance companies and things like that. In that time, it's very difficult to develop a relation in which you can give that sort of advice to your patient and have them listen. It's a lot of work. It's a lot of time. It's a lot of effort, so there kind of has to be more of an intimate relationship there. You have to talk to that person for more than seven minutes every six months or so.

Marcie: As I understand it, people with psoriasis are already trying many kinds of potential treatments. So, how do they find their way to you?

Dr. Neuzil: If you're looking for a good naturopath, I would recommend looking at the Web site www.naturopathic.org that's our national association, and it can give you a reference for a naturopath in your area.

Marcie: I understand you have psoriasis yourself.

Dr. Neuzil: I do. Well, I did.

Marcie: You did?

Dr. Neuzil: It was something that I battled with for probably about six years until I got to the point in medical school where I was able to manage it on my own and had the knowledge to fight it. But, for me, it was entirely dietary changes that helped.

Marcie: Is it something that you have to continue for your whole life then?

Dr. Neuzil: It's something that I have continued simply because I feel so much better just overall. I think I'm able, now that my skin is healed, to have more discretion with my diet. I can be a little bit more liberal and not see the effects, but on the whole my diet has changed pretty significantly.

Marcie: Dr. Amy Neuzil is a naturopathic physician based in Austin, Texas.

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